Head and Neck FNA Cytology

Workshop

Thyroid

Salivary glands

Lymph nodes

Massimo BONGIOVANNI Lausanne, Switzerland

Beata BODE-LESNIEWSKA Zurich, Switzerland

ECC 2016 Liverpool 5.10.2016 Wen 8.30-10.00

Neck • Lymph nodes

• Thyroid

• Salivary glands

• Soft tissue – Muscle

– Fetty tissue

– Nerves

• Pharynx

• Larynx

• Oesophagus

84 y; F 80 y; F 26 y; M

Pat 1 Pat 3 Pat 2

a) Lymph node

b) Thyroid

c) Salivary gland

d) Soft tissue

a) Lymph node

b) Thyroid

c) Salivary gland

d) Soft tissue

a) Lymph node

b) Thyroid

c) Salivary gland

d) Soft tissue

? ? ?

Interventional Cytopathologists

Lymph node

Tuberculosis

Parotis

Warthin tumor

Thyroid

Goiter

84 y; F 80 y; F 26 y; M

Lymph node enlargement

FNA

Direct smear (PAP stain)

Pure lymphatic population (no obvious large cell lymphoma)

Flow cytometry

• Granulomatous inflammation

• Metastasis

• Hodgkin lymphoma

• Large cell lymphoma Suspicous clinical setting

•Age > 50

•History of NHL

•Multiple enlarged lymph nodes

•Persistent lymphadenopathy of

unknown cause (especially in

repeated FNA)

Low clinical suspicion of NHL

•Age < 30

•Search for metastases with isolated,

slightly enlarged node

•Obvious cause (e.g. inflammation in the

regional tissues)

No flow cytometry Immunocytochemistry and/or special stains and/or FISH / PCR if indicated

IHC cell block: bcl1-, bcl2+, bcl6+

Follicular lymphoma, low grade

TTF1 nuclear postitivity

Adenocarcinoma of the lunge, metastasis

- no EGFR gene mutation

- no ALK1 gene aberration

Dir

ect

sm

ear

s C

ell

blo

ck

Standardized reporting of the FNAs

of the thyroid nodules • In Great Britain since 2003

• Bethesda System (USA) 2008

29 y; man FNA cyst in the right supraclavicular area; „non diagnostic“ FNA 2013 Recurrence, bigger than 2013

60 ml clear fluid

Acellular sediment

Parathyroidal cyst No signs of malignancy

• Whole Range of the FNA Cytology of the

– Salivary glands (1 )

– Thyroid (2 )

– Lymph nodes (3 )

• Mostly cell blocks available (HE)

• Some cases with US & FACS print outs

• In most cases (if possible) histological correlation (slides mostly included)

www.zytologie.usz.ch